Transcript
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00:07
Venky Ananth:
Hello, and welcome to Pacesetters. My guest today is Tim Skeen, Executive Vice President and Chief Information Officer, Sentara Health. I'm very excited today because Tim is an absolute industry veteran in healthcare. I've known him for about ten plus years now. From Molina and Amerigroup, Elevans Health previously used to be known as Anthem, and now with Sentara. A very progressive leader, a leader who is actually very closely aligned with technology, who's got very deep insight, both from an industry angle and from a tech angle. So very excited to have Tim. And Tim, welcome to Pacesetters.
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00:49
Tim Skeen:
Thanks for having me. Appreciate it.
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00:51
Venky Ananth:
First off, Tim, let's talk about Sentara. Just want us, our audience to know what Sentara Health is all about. Can you just share with us, what you do from breadth of market presence perspective and depth?
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01:06
Tim Skeen:
Yeah. So, Sentara is, what they call an IDN- integrated delivery network. it's been around for a long time in this region as a community asset. Over 135 years. And we both do health care delivery on the acute and ambulatory side for 12 acute hospitals and over 300 care facilities. And then we also have a health plan that's about half of our revenue. We have 1.2 million members, the majority of those being in the Medicaid space. So, we're really unique in the health system space as being a not for profit. That also has about equal balance of revenue on the care delivery side as well as on the health insurance side.
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01:47
Venky Ananth:
Awesome. So you spoke about integrated delivery networks and the unique piece being you are a health plan and a health system. So typically, what are the challenges of an integrated delivery network? You know, I mean, I have spoken to many leaders from the health systems side, leaders from the health plan side. But you are very unique in that sense. And especially for a CIO like you, what is the uniqueness in that and what are your challenges, Tim, if you just want to share your unique perspective on that?
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02:26
Tim Skeen:
Yeah. So, a big reason why I came to Sentara was to experience that side of care delivery integrated with health plan and health insurance- the financial side. You know, my previous 20 plus years were all with payers doing health insurance. And so understanding how to collaborate, and have seamless care across the spectrum of how you get health insurance, how you get care, and then how you pay for that health insurance-really got that chance to be exposed to that at Sentara. I'd say historically, what they call payviders…. So payviders are providers who have a health plan, have not been as much focused on that health plan as an area of growth and of integration for overlap. And they really have kept a lot of their..in some cases their technology separate, their data separate…There was a lot of hesitancy historically to how to silo those two pieces.
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03:19
Tim Skeen:
And what we have here is a great opportunity to think about how to leverage those things as connected systems. And so having that breadth across the entire enterprise- acute, ambulatory and from a health insurance standpoint allows me as a CIO responsible for all of that-including all data and analytics- to see where are the places where we're connected, where are we disconnected, where are the gaps, and how do we get that continuity of care across a member patient who's also experienced our care delivery on the health system side, as well as being a member of our health plan. And then secondarily, how does that same patient get connected with other health care, health insurance plans to help with some of their care coordination and all in the sense of trying to get the best health outcome for our customers.
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04:09
Venky Ananth:
Right. Tim, do you think that by virtue of the fact that you are both, you know, from a patient or a member experience perspective.. access to care or quality of care or even the experience of going through the health care process…is that superior? What are your perspectives on that? And does your positioning give you that unique advantage to deliver a far better access and quality of care?
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04:39
Tim Skeen:
Yeah. No, it's a great question. You know, our point of view- and that's why we've just kicked off a three year strategy called One Sentara- is that that experience should be ultimate for those folks who are both our patients as well as our health plan members. And so I don't know we're there right now but the belief is that that experience should be delightful across that spectrum. Right now, we have about 18% of our patients who are also members. We need to grow that considerably over the next three years. And part of that growth is also making sure that they're connected and how they get care, how they pay for that care.. that it's seamless, it's intuitive and it's understandable.
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05:23
Tim Skeen:
And there's a couple of ways we're trying to do that with One Sentara. The number one way is trying to bring it through an enterprise shared service care management. So, if you think about population health and care manager, you hear about value based care, right? In the industry, this is our opportunity to show that across all of our consumers: both patients and members. And so, right now, if you're a patient at Sentara and you're also a health plan member, it's possible. But the care managers from both sides could be both calling you about the same gaps or different gaps. And so you're getting these nudges. You're getting confusion. And you figure out where is the right, trusted source to get your information.
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06:03
Tim Skeen:
And we all know that right now, for us, the advantage we have over my days of being in the payer side is that patients trust their doctors. Patients trust the clinicians first to guide them. And so, having that relationship of trust, we really need to treat that with respect and leverage that in terms of how we address and interact with our member and when they have to be patient. Hopefully they oughtn't have to be patients. But how do we guide them for better outcomes of health and wellness and go to that spectrum where they're not just coming to us when they have acute events and have to go get a surgery or go into the ED, or they're only coming to us when they have to worry about paying a bill. So that's really the opportunity. And I think, you know, the way we're organizing our platforms are connected data and then our operational shared services like care management, We believe that we can give that holistic, best experience to that One Sentara customer.
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07:04
Venky Ananth:
Incredible. I mean, I call this jokingly, BFF, which is broken, fragmented and frustrating. That’s typically… I'm talking at a broader level at a healthcare, what you just spoke about. Because you have, like you said, the care manager from the health plan calling and the provider calling for the same piece of data. And that's kind of broken from an experience perspective. So this is spot on in terms of addressing the core need of the industry in terms of kind of giving that unified experience. We just want to talk about the data piece that you mentioned. You know, you are being very progressive, and I shared that in the introduction statement. You're a technology veteran too. How have you leveraged, you know, tech like cloud, etc., especially in terms of data sharing, the ability to interoperate, to kind of give that consumer experience that is a lot more, you know, consumer grade, right? We're used to it in the retail industry. We are used to products like Microsoft or Apple, etc., right, in terms of data portability. But in the healthcare industry, you know that it's still not as seamless as one would like. How have you leveraged the power of data, cloud to kind of at least begin to move in that direction, especially with this One Sentara way that you spoke about?
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08:30
Tim Skeen:
Well, fortunately, when I came here, the team was already on a journey to getting to the cloud. And so ,that journey started over six years ago. We actually spun out a cloud transformation company called OptaFi out of that experience. And that asset that we created in terms of how to do that inside of a health system and a health plan to get all the assets out there. Now, I'm happy to say we're about 85% in the cloud. So that is a huge, huge advantage as a start when you're talking about bringing data together, big data, bringing in third party data and then applying, you know, AI and large scale techniques to that data. So I feel very fortunate that our platform and our data stores are already on the cloud and leveraged in our own secure instance.
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09:21
Tim Skeen:
The next steps that we're taking are how do we create a personalized consumer data hub? How do we create a provider data hub that has the right accuracy to connect folks and to also personalize the interaction with us? So, that journey, we started a couple of years ago, brought in a chief data officer, have a chief analytics officer, and we're making a lot of progress in that enterprise data platform. The next things we're doing to that is how do we inject that with a lot more third party data. SDOH data- social determinants of health data, how do we bring in other financial data, social data, other data that allows us to personalize but then also, you know, guide them on the full care from wellness, activity, nutrition all the way to potentially acute care, God forbid if they need that.
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10:09
Tim Skeen:
So, how do we get that data across that whole spectrum and instrument it and collect it. So, that's a bunch of different things. That's digital assets, that's virtual care with remote patient monitoring and other wearables, getting that data in those fumes to feed into that larger data store and then connecting it, because I think we already have the foundation there. We have the connectivity across your administrative services on the health plan, as well as your clinical data that's happening on there. Now we just need to enrich it, take it up the scale and then start applying algorithms, machine learning and AI to provide insights, self-service and all those things we think will be able to meet the patient where they want to meet us, whether that's in, you know, out there and, you know, in the digital interaction self-service or if it's actually in one of our facilities where we have virtual nursing and other digital assets to interact with in an actual facility of ours as well.
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11:05
Venky Ananth:
So ,where are you in that journey, Tim, in terms of actually having one cogent set of data, clean data that you can actually apply all the things you spoke about, be it analytics, be it build, models, transformation models for AI etc..…where are you really in that journey?
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11:26
Tim Skeen:
Yeah. So it's, you know, that journey will never end because there's more and more data every day and cleaning it and connecting and attributing it to our consumers is really important. And it takes a lot of effort. So we have unified the data connectivity between the health plans and health systems. So our operational systems that are generating data and usage, we have that connected to understand that across the spectrum. We have a number of external data sets connected, a few EMRs for other external providers connected in terms of flowing that data, and starting to introduce SDOH data in the geographies where we live. And so that piece is coming in.
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12:10
Tim Skeen:
We've also created a research data store using an OMOP data model, which is the standard data model for sharing for clinical trials and research with other academic hospitals.So, that's in place. And then we leverage, two other…three other large data stores. One is TriNetX for some of our identification for trials and clinical trials. We use Epic Cosmos, which is a shared large data store across all of Epic's customers across the country. So a massive amount of data for millions and millions and millions of Americans. And we also invested early on, three years ago in a consortium that started up with about 26 health systems called Truveta, that spun out of Providence Health, where they were providing once again a large, de-identified data set that we can do research, we can see patterns of care about what works across all regions, not just in our geographies, and then apply that to how to get the best outcome for our patients.
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13:12
Venky Ananth:
Very exciting….in terms of what you're doing. I want to shift gears. I want to talk about innovation, Tim, and, Sentara has always been a trailblazer from an innovation perspective. I’m talking about clinical innovation. You know, back in…I was fascinated to understand that back in 1967, Sentara was one of the leaders in terms of doing the first open heart circuit here in this region. And then in-vitro fertilization- again, the first in the nation, and then air ambulance in 1982. So, a lot of new stuff, pushing the envelope and being the leader there. Now, I'm kind of overlaying that with what's in store for the future. And obviously, no conversation, especially tech conversation, is complete without talking about AI. So I want to, I want to really bring that into the mix, because obviously this is also a boardroom conversation. How do you see and marry the spirit of innovation that Sentara is always known for- combine that with the exciting innovation that's happening in the tech industry, and how do you see the future unravel from your perspective?
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14:23
Tim Skeen:
Yeah, well, it is very exciting, you know, for a number of reasons. I would also add just 20, almost 25 years ago, we were the first one to create an e-ICU. We had a virtual ICU inside of a bunker way before virtual care was, you know, was hot. So, and we're expanding into that area as well, to go virtual…
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14:40
Venky Ananth:
eICU- what does that stand for?
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14:42
Tim Skeen:
So, that's, so the electronic ICU. So, basically being able to connect a bunker across our ICUs, across all of our hospitals spread out over the, over the region. So it allows us to concentrate and have another, we'll say command center that's monitoring our ICUs. But yeah, going back to AI and the excitement around it….So I would say, you know, in my 30 plus years of being in this technology industry, this is unique and this is the first time that it isn't me trying to take a hot technology and try to sell it to the C-suite, to our board. This is them coming to us because it's got such exposure that everybody's like, well, we got to.. What's this AI stuff? We gotta jump on. It's really caught the mind in the media from a social standpoint and from a fear standpoint, right? What is it? You know, is it all goodness? Is it going to be badness? You know, what is the mix of that?And so really in the process, the first thing when they, you know, coming to get with the C-suite, to get with the board and say, okay, what is AI? Because AI has been around for 30 plus years. So start defining what AI is, because obviously gen AI is what has caused the big spurt later in terms of, really a leapfrog in terms of what we can do and the kinds of things it can do in terms of our operations and for the health and society as well. So once we define and set aside- here, these are the types we're doing here. Basic automation. Here we're doing basic machine learning or predictive models. But gen AI is really the new horizon.
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16:12
Tim Skeen:
How are we going to leverage and use that? And I was happy that they came to us early. We got governance put in place around it to make sure we are covering the risks of bias, you know, any ethical uses of it and make sure it was the right fit for the organization. And we started looking at leveraging some of our partners two years ago. And we've been live for probably about the past year with AI assisted information, both in ambient listening. So if you think about Nuance’s DAX Copilot as an assistant helping in primary care, so you can have that interaction with the patient, capture that data, get it into the EMR, help also code it, make it more succinct, readable, give time back to the clinician to spend more time with the patient. So that's one thing that we're continuing to roll out now as we speak. And we think there's a tremendous amount of value that can happen to that. Because once you're capturing that ambient listening and then you're applying intelligence to it, hope you're going to capture care gaps and you're going to avoid other, you know, other bad, outcomes that could happen by not being informed with drug history. And that's why it's so important to say, are you getting all this other data to fully inform the 360 view for this patient your buying against that?
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17:29
Tim Skeen:
The second investment that we're doing, with a company called Regard, is once again assistive technology using AI and our first production use of gen AI in clinical care. So we've put this in.. roll this out to all of our hospitals, to our hospitals and APPs that are rounding and taking care of our patients. And what it does is it goes..it's integrated into our EPIC system. It looks at all of their history. It brings all that history in and helps formulate concepts of gaps, things to look out for-other conditions and issues. And it brings that all into the hospital's view. And it's not doing it automatically and diagnosing it. It's bringing it to the hospital for they can quickly pick what things make sense and move that into the documentation. And then, the beauty of it, once you had your full episode of care through that process and it's constantly updating you based on all the additional data that's coming for you in your, in, in your acute setting facilities’ stay. At the end, it helps, right? It takes all the hundreds and hundreds of pages of notes, results, tests and input from all the different clinicians. And it creates a discharge summary. That succinctly generates that using Gen AI, our own private, trained, LLM instance to give that discharge summary. And it saves time for the hospitals.
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18:55
Tim Skeen:
And it also, we're finding, is more useful for the post-op acute services for the providers to be able to read and actually provide a holistic, full, complete, post-acute care for that patient. And we're seeing, you know, and that was a process, right? We had to bring that into a private instance. We had to go through the training. We had to go through the hallucinations, and through that process took, 4 or 5 weeks to get to that. But now we're seeing tremendous results. And once again, the most important part about Gen AI, at this current stage is that it has expert for review and expert validation. So nothing goes out that comes out of Gen AI that doesn't have the physician actually reviewing, assuming and signing off on. But it's still getting that information done very quickly for them, giving them back more time with the patient and what they say, you know, more TV time at night, right? So where they're not having to do documentation for hours and hours after they've done a long day at the facility.
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19:57
Venky Ananth:
Phenomenal. I mean, AI is happening here and now in production?
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20:03
Tim Skeen:
Yeah
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20:04
Venky Ananth:
Amazing. How has been the uptake by clinicians and practitioners? Are they seeing this as a powerful assistant to their own profession? Or are they feeling a little more intimidated? How is the change management from that perspective?
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20:20
Tim Skeen:
Well, you know, like many things, when you're introducing any technology, right, the technology is only as good as the adoption and the change management of the users of that technology, right, assuming it's not all fully automated. So, you know, it's been a journey with doing that. If I think about some of the automation, you know, back, you know, even five, ten years ago, where they would say, hey, you're going to get rid of our jobs. You're trying to replace us. So, it's gone from that to them understanding, hey, this is a real assistive tool that's going to make me a better clinician.And they're starting to embrace that.
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21:03
Tim Skeen:
And I see that in different generations of clinicians, there's different levels of embracing that. But a lot of that comes with: one, the technology-how intuitive and easy is it to adopt. And then how do you have your champion, your clinician champions who are helping with the change management, getting excitement and making sure that the workflow and how they work going forward? Just a few weeks ago, I went, I shadowed at one of our hospitals. And I spent half a day with a hospital that had only been there a year. It was relatively young hospital and, a hospital that has been there for 25 years with Sentara. And it was interesting to see them interact with that tool. The one that’s only been there a year was fully engaged. They were like, this is great. I bring all this stuff in. Yeah, it doesn't maybe help me with ortho cases, but it helps me with everything else. Loving it. And they're adopting all of that piece and embracing it. About how it's making them more effective and more efficient. Now, the physicians that have been here 25 plus years, they were also saying, yeah, this is good. You'll see this. That makes sense. And this is helpful. And they're doing that but at the same time, they're also making sure that you know that, yeah, but I probably would have caught that or I would have done that. And my template is a little bit faster than maybe this. So, it's a little bit of a caveat in how it's assisting me. But you're also seeing that adoption and assistance, right?
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22:22
Tim Skeen:
So I would say when I roll out technology, especially clinicians, the adoption rate is in a lot of cases are well below 50%. The early days of Dax, right from nuance, for ambient listening was probably less than 25%. They just messed with it. They said I couldn't figure this out. It’s too hard. And they just said, I'm turning it off. What we're doing with the hospitals with Regard, and Max, which is the LM component, we have just over 70% adoption and that's without anybody saying you must do this. So that's a great sign: when people find it intuitive and helpful and they naturally adopt it, which is helpful when it's embedded in the EMR, it's embedded in their workflow, and it's making their life better. You don't have to sell it. And so I think you're going to see more and more AI and Gen AI opportunities to help with the clinicians and then also help with the consumer, right?
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23:20
Tim Skeen:
Because the consumers really, you know, they want to do self-service. They want to help with triage, right? They're already doing it. They're already googling, right? I mean, so they're already trying to do it themselves. How do you do it in a contained way that gets them to the right point of service that says, hey, listen, yeah, you know, you don’t need to go to the EDR. No, you can just do a metalahealth with an MA and get what you need. I think you need to figure out- where to meet them, where they're at. And these services will help assist that. There’s still a little ways to go because there's a lot of literacy issues. Not just digital literacy, but, you know, medical literacy to make it understandable, to make it, you know, so they can absorb that. Because what I would say is, you know, the difficulty in this space…because I've seen some very cool virtual, AI solutions, especially, so I went in a few weeks ago at a conference, in the telecommunications space where you have this virtual store. And that's very cool. And adopting.
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24:20
Tim Skeen:
But the problem is we're selling a service that consumers don't want. They don't want to have to go to the hospital.They don't want to have to go to their doctor, right? You know, so if you can make that understandable and easy and you can broaden that to the health and wellness of their whole life, their family, their nutrition, their exercise, just your whole, you know, say whole health view of them..then I think they can embrace it. And then we can have the touch points because we're never going to be personalized or get that consumer engagement if you're in a healthcare delivery system, which on average has 2.7 interactions with you a year. How am I going to engage you if I'm having 2.7 interactions with you a year? So we got to figure out how to change that model. And a lot of that model can scale by leveraging data, AI, Gen AI and other digital means to engage them.
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25:13
Venky Ananth:
Fascinating. I want to shift gears to the health plans side, Tim. One is on the… especially on the Medicaid. We were just talking about it in terms of that being core to your business. There's been a lot of redetermination that's happened of late. How is that shaping up and how do you see the future from a Sentara perspective?
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25:36
Tim Skeen:
Yeah. So, redetermination, which.. everybody understands that or doesn’t understand, but obviously when elderly redetermination was paused during Covid, the roles increased. That got us more membership, got us more revenue. And so that was generally a very good thing- that we can continue to invest in and creating a better solution to support our customers. But now redetermination is shrinking that. And there's two pieces to that. Obviously we've got to get more efficient with smaller scale of membership. But the second piece of that is we got to make sure that we don't have people fall through the cracks in that safety net, because in a number of states and areas that redetermination is not happening consistently and it's not happening equitably, right?
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26:21
Tim Skeen:
So there's lots of people losing their coverage that shouldn't be losing it. That's because they don't know how to navigate, to make sure that they still get plugged into the system and enrol. So we're trying to guide services to help with that, to make sure if people are eligible for that care that they're getting it and don't fall through the cracks. Now, the second piece of that, which is the good story, is that we also have a really competitive and high performing individual exchange business. So if you think about bronze, silver and gold layer. So what you're seeing, right, is that with redetermination we're losing people. It's, you know, if we had that great experience and they trust us, and the customer likes Sentara, they're naturally flowing into our individual exchange business. And so that business helps with that- still making it affordable and subsidized for the consumer. But it also allows us to do the continuity of care because we have experience with them historically. So we can keep that experience, pro-active care, preventive medicine, and keep them engaged with the physicians and clinicians that they trust and are used to interacting with.
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27:28
Venky Ananth:
I wanna ask you a personal point of view here. You had a long tenure with health plans, working with big national health plans. Now, you also are working for it an IDN. What is your view, you know, what are the huge advantages that an IDN like Sentara brings to the table from an industry perspective that the health plan is not able to and and vice versa, right? There are obviously pros and cons for everything. How do you see this? And what would you…where does your vote go to?
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28:08
Tim Skeen:
Yeah. So, you know, it's very interesting because I think everybody in the health care ecosystem would say they have a mission of trying to improve health every day for the consumers out there in the space. It's slightly different in an IDN environment for… in two ways. If you're a pure health system, you're actually about mission, making sure that you're giving a care when needed in acute settings and day to day, you're trying to keep them healthy. As a payer, you're trying to make their plan affordable and easy to use, and hopefully cover them in any catastrophic events. But when you're both, you have that perspective that says, yeah, I'm going to try to do this all economically and care delivery to help balance that. You have a little more flexibility around right pocket, left pocket in terms of …. So for instance, authorizations. If you're going to come into one of our hospitals with a large event, we know you're going to max out a pocket on our health plan. Why make you go through hundreds of bills and send you all that ,and go through this whole authorization process, when we know you're going to max out? Let's get that done up front and then let you worry about getting better in the care and not have all of this residual notifications, letters, bills for the next six months that you got to be confused and resolved about whether you're going to pay them, who they came from.
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29:31
Tim Skeen:
So how do you make that? Once again, a continuous, easy to navigate environment. So I think that's, you know, a huge benefit. The other benefit that I think is really interesting, since… value based care, value based contracting, hot health…however, whatever you want to call it in the industry. But my, you know, when I was on the plans side, you're trying to push clinicians to do what you think they should be doing in a value based care to incent them and also to have the best financial outcome. That's natural, right? And a lot of those are for profits where a lot of the health care delivery is not for profit. So, part of the problem is that when you're in a big organization like I was, you're driven for the shareholders, you're driven to win. And so when can be 51:49, it can be 55:45, but you're driven to win. And really the way to win for the consumer is to have equal incentive for the best outcome and be win-win on both sides.
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30:32
Tim Skeen:
But the problem is that generally in those negotiations, whether you want to talk about provider contracting, networking contracting or value based care, everybody's trying to get that edge. And at some point we're going to say, listen, we just need to work together to get the right outcome. And that's easier to do when you own both sides of that equation. And you can sit back and have a little more flexibility of being not for profit, not worrying about quarterly earnings, not worrying about EPS and the shareholders. So that's a very different perspective. I don't know if we can change that because the dynamics of the for profits, but for the sustainability, and for the, you know, for the best outcome for the country in terms of our consumers’ health, we've got to figure that out.
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31:21
Tim Skeen:
And, you know, we're not going to become a single, you know, government-run health care organization. We're not going to be that like some other countries are. It just isn't going to happen. But we do know that the broadest risk pool of all of our citizens is the best way to balance how you can afford and pay and sustain the cost of health care across this organization. And that allows you to work together and hopefully eliminate a lot of waste that's happening administratively in the system.
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31:51
Venky Ananth:
Deep, deep responses as I could expect from you, Tim. I appreciate that deep insight because that comes from, wisdom codified over many years, I can see.
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32:03
Tim Skeen:
Or frustration, yes.
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32:05
Venky Ananth:
You could say that. But, you know, only from real world experience, you kind of get to improve the system. Just to wrap up, Tim, one last question is, looking ahead, what are your top two, three priorities, as the CIO of Sentara? What are you gonna look at? Because you already spoke about how you've already started the journey of AI. You already spoke about how you migrated massive amounts of data to the cloud. You already have a setup for ensuring that data can be leveraged effectively to drive far better clinical care outcomes etc. You already spoke about how adoption of AI technologies, here and now. You spoke about the innovation that you're driving in the field. And of course, you also spoke about on the health plan side, how you are kind of driving interesting stuff in Medicaid, expanding market share and of course, the fact that you have an advantage of being both a health plan and a health system to kind of focus on that consumer experience and member experience that you really care about. So with that on the background, how does the future look like for Tim and, what are your top two, three priorities that you are really looking at for Sentara?
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33:21
Tim Skeen:
Right, I would put them in. So I'll do the easy ones, right? So, the easy one around technology from a focus standpoint is definitely around enabling the capability to do population health. And so that's some workflows, that’s some operational system. That's absolutely data. Fluidity, right? It has to be ubiquitous. Digital assets. There's going to continue to be… that has to be doubled down on and digitized. More and more things, whether it's operational workflows or actual tech that interacts directly with consumers. And then it's around, I think, how do you drive value based care? So, what tools will allow you both the data and other tools to have that seamless environment?
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34:10
Tim Skeen:
So, I think those are kind of the big bets in technology. So that, you know, is, at a tech specific, right, that's digital, that's data, analytics. And it's virtual care enablement, right. So, that's tech which underlies…just that's just the tool bag, you have to figure out how you're going to support the business. You know, we still have a long ways to go with kicking off our One Sentara strategy, right. So that's a whole mindset change. Change management process, culture change, right? Only now are we starting to see-a year into it- folks inside the hospitals thinking and knowing about the health plan or thinking about inventory, the health plan, thinking about the impact of doing something, whether it's new technology or new operational change, how does it impact that other areas of business? How does it impact home health? I mean, so that culture change and that whole shift, now that is truly turning this the Titanic, right? Because we've got, what, 31, 32,000 employees where pretty much 80% of those are clinicians and 20% of those are health plan and administrative. So how do you get that mass bolus of clinicians that are spread across the country that are trying to focus on individual's health?
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35:30
Tim Skeen:
So, also then, think about the other interdependencies of how I finance that health, how they get paid, how they're going to worry about authorizations, understanding that full continuum. So the more that our folks can understand the full picture of how we serve, and then we can think about not just what's best for our particular division or our particular incentive, but for the system as a whole. I think what that will do over time is change how the consumer is feeling, so they'll feel it more personally. They'll feel more united. And that feeling, I think will feel like some optimism around how their health can be managed and benefited for their lifetime and for their, their families.
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36:13
Venky Ananth:
That pretty much sums up the essence of One Sentara, I suppose. So, good luck on that.
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36:19
Tim Skeen:
Yes.
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36:20
Venky Ananth:
And thank you for sharing your insights, and what's up for the future. So, thank you so much, Tim.
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36:25
Tim Skeen:
I appreciate the time. Thank you.
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36:27
Venky Ananth:
Thanks.
